Li Yanfang, Finkel Kevin W, Hu Wei, Fu Siqing, Liu Jihong, Coleman Robert, Kavanagh John J
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 1155 Pressler Street, Houston, TX 77030, USA.
Gynecol Oncol. 2007 Aug;106(2):375-80. doi: 10.1016/j.ygyno.2007.04.011. Epub 2007 May 18.
A paucity of data exists regarding the efficacy and toxicity of pegylated liposomal doxorubicin (PLD) in cancer patients with chronic kidney disease (CKD). We sought to investigate the toxicity and efficacy of PLD in gynecologic cancer patients with CKD.
The clinical records of all patients with recurrent gynecological cancer and CKD at the University of Texas M.D. Anderson Cancer Center from 08/1999 to 08/2006 were reviewed retrospectively to identify patients who received PLD.
Twenty-eight patients were identified, which included 14 with epithelial ovarian cancer, 4 with peritoneal cancer, and 10 with other gynecologic cancers. CKD was defined as a creatinine clearance (CrCl) of <90 ml/min/1.73 m(2) and classified as mild (5 patients), moderate (16 patients), or severe (7 patients) (CrCl 60-89, 30-59, and <30 ml/min/1.73 m(2), respectively). The initial doses of PLD were classified into regular initial dose (40 mg/m(2)/4 weeks) and lower initial dose (30-35 mg/m(2)/4 weeks). The median cycle was 4.5 (range 1-17). The incidence of grade 3-4 palmar-plantar erythrodysesthesia, stomatitis, and hematologic toxicity was 11.1% (2/18), 5.6% (1/18), and 16.7% (3/18) among 18 patients with an initial dose of 40 mg/m(2)/4 weeks, which included 5, 10, and 3 patients with mild, moderate, and severe CKD, respectively. Dose reduction due to toxicities occurred in 33.3% (6/18) patients. In 18 patients with ovarian and peritoneal cancer (all platinum-resistant), the rates of complete response, partial response, stable disease, and progression were 0%, 11.1%, 44.4%, and 44.4%, respectively.
Patients with CKD who received PLD therapy at an initial dose of 40 mg/m(2)/4 weeks may require greater subsequent dose reduction mainly secondary to mucocutaneous and hematologic toxicities. Treatment response in this population with ovarian and peritoneal cancer was similar to that of patients with normal renal function.
关于聚乙二醇化脂质体阿霉素（PLD）在慢性肾脏病（CKD）癌症患者中的疗效和毒性的数据较少。我们试图研究PLD在患有CKD的妇科癌症患者中的毒性和疗效。
回顾性分析了1999年8月至2006年8月在德克萨斯大学MD安德森癌症中心的所有复发性妇科癌症合并CKD患者的临床记录，以确定接受PLD治疗的患者。
共确定了28例患者，其中包括14例上皮性卵巢癌患者、4例腹膜癌患者和10例其他妇科癌症患者。CKD定义为肌酐清除率（CrCl）<90 ml/min/1.73 m²，并分为轻度（5例）、中度（16例）或重度（7例）（CrCl分别为60 - 89、30 - 59和<30 ml/min/1.73 m²）。PLD的初始剂量分为常规初始剂量（40 mg/m²/4周）和较低初始剂量（30 - 35 mg/m²/4周）。中位周期为4.5（范围1 - 17）。在18例初始剂量为40 mg/m²/4周的患者中，3 - 4级手足红斑感觉异常、口腔炎和血液学毒性的发生率分别为11.1%（2/18）、5.6%（1/18）和16.7%（3/18），其中包括轻度、中度和重度CKD患者分别为5例、10例和3例。33.3%（6/18）的患者因毒性反应而减量。在18例卵巢癌和腹膜癌患者（均为铂耐药）中，完全缓解、部分缓解、疾病稳定和进展的比例分别为0%、11.1%、44.4%和44.4%。
初始剂量为40 mg/m²/4周接受PLD治疗的CKD患者可能需要更大幅度的后续剂量减少，主要是由于皮肤黏膜和血液学毒性。该人群中卵巢癌和腹膜癌的治疗反应与肾功能正常的患者相似。
